Mental health services for adults with mild intellectual disability

Meeting the mental health needs of people with mild intellectual disability (ID) can be a challenge to all mental health services. Not everyone with ID will be eligible to receive specialist ID services and therefore they rely on general mental health services to support them. The purpose of this College Report is to both inform readers on the complexities of providing care for this group of people, and how general and specialist services can co-operate to meet their needs. It is aimed it at psychiatrists and clinical staff working at the frontline of psychiatric services, and general practitioners providing services for people with ID. It includes: A review of service provision for people with mild ID across the four countries of the UK An oversight of the current evidenced-based thinking on what constitutes mild ID from an operational diagnostic perspective. The role, challenges and ambiguities of cognitive testing in this population. The Report’s conclusions are reinforced by the systematic review of current evidence on how care for this population is delivered that was undertaken and the review of all relevant NICE guidance on mental health applicable to people with ID that is provided. Drawing on the evidence, the Report also makes available a broad good-practice framework to enable psychiatrists, other practitioners, and services to self-measure and provide high quality care for people with mild ID and mental health problems

PREDICTION OF ANKLE JOINT TORQUES USING ARTIFICIAL NEURAL NETWORKS

Major ankle sprains in sports are thought to be due to high levels of ankle torsion. The purpose of this study was to develop a method for measuring in vivo ankle torques developed by athletes. Motion capture, force plate, and insole pressure measurements were used to develop generalized regression neural networks to predict maximum ankle torque and rate of ankle torque based on insole pressures. It was found that network prediction accuracy depended on the number of subjects used for training, as well as the method of pressure sensor grouping. Further work will be performed to determine optimal subject and pressure sensor groupings

Primary Care Case Conferences to Mitigate Social Determinants of Health: A Case Study from One FQHC System

Objective: Given the increasing difficulty healthcare providers face in addressing patients’ complex social circumstances and underlying health needs, organizations are considering team-based approaches including case conferences. We sought to document various perspectives on the facilitators and challenges of conducting case conferences in primary care settings. Study Design: Qualitative study using semi-structured telephone interviews Methods: We conducted 22 qualitative interviews with members of case conferencing teams, including physicians, nurses, and social workers from a Federally Qualified Health Clinic, as well as local county public health nurses. Interviews were recorded, transcribed, and reviewed using thematic coding to identify key themes/subthemes. Results: Participants reported perceived benefits to patients, providers, and healthcare organizations including better care, increased inter-professional communication, and shared knowledge. Perceived challenges related to underlying organizational processes and priorities. Perceived facilitators for successful case conferences included generating and maintaining a list of patients to discuss during case conference sessions and team members being prepared to actively participate in addressing tasks and patient needs during each session. Participants offered recommendations for further improving case conferences for patients, providers, and organizations. Conclusions: Case conferences may be a feasible approach to understanding patient’s complex social needs. Participants reported that case conferences may help mitigate the effects of these social issues and that they foster better inter-professional communication and care planning in primary care. The case conference model requires administrative support and organizational resources to be successful. Future research should explore how case conferences fit into a larger population health organizational strategy so that they are resourced commensurately

Plasticity of topologically close-packed phases in the Fe-Ta(-Al) system

Understanding the structure-property relationships of materials plays a significant role in the development of materials for technical applications. Due to the many possible combinations of two or more elements, intermetallic phases can be very interesting for these developments. High strength up to high temperatures makes intermetallics promising materials for high-temperature applications. However, their complex structure, resulting in a pronounced brittleness, has so far limited their applicability. We focus on the understanding of plastic deformation in topologically close-packed (TCP) phases, which form one of the largest groups of intermetallics. To do this, we use nanomechanical tests that allow us to study plasticity even in the most brittle materials. Here, we consider the Fe-Ta(-Al) system that contains two closely related TCP phases, a C14 Laves phase and a µ-phase. The building block-like structure of these phases enables a systematic investigation as well as a transfer of the findings to other complex crystals. The mechanical properties of the two TCP phases in the Fe-Ta(-Al) system, investigated by state-of-the-art micromechanical testing, are introduced in this work. The influence of the crystal structure and chemical composition on the mechanical properties and the deformation mechanisms of the TCP phases are discussed

AngularGrad: A New Optimization Technique for Angular Convergence of Convolutional Neural Networks

Convolutional neural networks (CNNs) are trained using stochastic gradient descent (SGD)-based optimizers. Recently, the adaptive moment estimation (Adam) optimizer has become very popular due to its adaptive momentum, which tackles the dying gradient problem of SGD. Nevertheless, existing optimizers are still unable to exploit the optimization curvature information efficiently. This paper proposes a new AngularGrad optimizer that considers the behavior of the direction/angle of consecutive gradients. This is the first attempt in the literature to exploit the gradient angular information apart from its magnitude. The proposed AngularGrad generates a score to control the step size based on the gradient angular information of previous iterations. Thus, the optimization steps become smoother as a more accurate step size of immediate past gradients is captured through the angular information. Two variants of AngularGrad are developed based on the use of Tangent or Cosine functions for computing the gradient angular information. Theoretically, AngularGrad exhibits the same regret bound as Adam for convergence purposes. Nevertheless, extensive experiments conducted on benchmark data sets against state-of-the-art methods reveal a superior performance of AngularGrad. The source code will be made publicly available at: https://github.com/mhaut/AngularGrad

Effects of surgical side and site on mood and behavior outcome in children with pharmacoresistant epilepsy

Children with epilepsy have a high rate of mood and behavior problems; yet few studies consider the emotional and behavioral impact of surgery. No study to date has been sufficiently powered to investigate effects of both side (left/right) and site (temporal/frontal) of surgery. One hundred patients (aged 6-16) and their families completed measures of depression, anxiety, and behavioral function as part of neuropsychological evaluations before and after surgery for pharmacoresistant epilepsy. Among children who had left-sided surgeries (frontal = 16; temporal = 38), there were significant interactions between time (pre to post-operative neuropsychological assessment) and resection site (frontal/temporal) on anhedonia, social anxiety, and withdrawn/depressed scales. Patients with frontal lobe epilepsy (FLE) endorsed greater pre-surgical anhedonia and social anxiety than patients with temporal lobe epilepsy (TLE) with scores normalizing following surgery. While scores on the withdrawn/depressed scale were similar between groups before surgery, the FLE group showed greater symptom improvement after surgery. In children who underwent right-sided surgeries (FLE = 20; TLE = 26), main effects of time (patients in both groups improved) and resection site (caregivers of FLE patients endorsed greater symptoms than those with TLE) were observed primarily on behavior scales. Individual data revealed that a greater proportion of children with left FLE demonstrated clinically significant improvements in anhedonia, social anxiety, and aggressive behavior than children with TLE. This is the first study to demonstrate differential effects of both side and site of surgery in children with epilepsy at group and individual levels. Results suggest that children with FLE have greater emotional and behavioral dysfunction before surgery, but show marked improvement after surgery. Overall, most children had good emotional and behavioral outcomes, with most scores remaining stable or improving. © 2014 Andresen, Ramirez, Kim, Dorfman, Haut, Klaas, Jehi, Shea, Bingaman and Busch

Pilot Randomized Trial of Active Music Engagement Intervention Parent Delivery for Young Children With Cancer

Objectives: To examine the feasibility/acceptability of a parent-delivered Active Music Engagement (AME + P) intervention for young children with cancer and their parents. Secondary aim to explore changes in AME + P child emotional distress (facial affect) and parent emotional distress (mood; traumatic stress symptoms) relative to controls. Methods: A pilot two-group randomized trial was conducted with parents/children (ages 3-8 years) receiving AME + P ( n  =  9) or attention control ( n  =  7). Feasibility of parent delivery was assessed using a delivery checklist and child engagement; acceptability through parent interviews; preliminary outcomes at baseline, postintervention, 30 days postintervention. Results: Parent delivery was feasible, as they successfully delivered AME activities, but interviews indicated parent delivery was not acceptable to parents. Emotional distress was lower for AME + P children, but parents derived no benefit. Conclusions: Despite child benefit, findings do not support parent delivery of AME + P

Memory systems in schizophrenia: Modularity is preserved but deficits are generalized

OBJECTIVE: Schizophrenia patients exhibit impaired working and episodic memory, but this may represent generalized impairment across memory modalities or performance deficits restricted to particular memory systems in subgroups of patients. Furthermore, it is unclear whether deficits are unique from those associated with other disorders. METHOD: Healthy controls (n=1101) and patients with schizophrenia (n=58), bipolar disorder (n=49) and attention-deficit-hyperactivity-disorder (n=46) performed 18 tasks addressing primarily verbal and spatial episodic and working memory. Effect sizes for group contrasts were compared across tasks and the consistency of subjects\u27 distributional positions across memory domains was measured. RESULTS: Schizophrenia patients performed poorly relative to the other groups on every test. While low to moderate correlation was found between memory domains (r=.320), supporting modularity of these systems, there was limited agreement between measures regarding each individual\u27s task performance (ICC=.292) and in identifying those individuals falling into the lowest quintile (kappa=0.259). A general ability factor accounted for nearly all of the group differences in performance and agreement across measures in classifying low performers. CONCLUSIONS: Pathophysiological processes involved in schizophrenia appear to act primarily on general abilities required in all tasks rather than on specific abilities within different memory domains and modalities. These effects represent a general shift in the overall distribution of general ability (i.e., each case functioning at a lower level than they would have if not for the illness), rather than presence of a generally low-performing subgroup of patients. There is little evidence that memory impairments in schizophrenia are shared with bipolar disorder and ADHD

Association of Thalamic Dysconnectivity and Conversion to Psychosis in Youth and Young Adults at Elevated Clinical Risk

IMPORTANCE: Severe neuropsychiatric conditions, such as schizophrenia, affect distributed neural computations. One candidate system profoundly altered in chronic schizophrenia involves the thalamocortical networks. It is widely acknowledged that schizophrenia is a neurodevelopmental disorder that likely affects the brain before onset of clinical symptoms. However, no investigation has tested whether thalamocortical connectivity is altered in individuals at risk for psychosis or whether this pattern is more severe in individuals who later develop full-blown illness. OBJECTIVES: To determine whether baseline thalamocortical connectivity differs between individuals at clinical high risk for psychosis and healthy controls, whether this pattern is more severe in those who later convert to full-blown illness, and whether magnitude of thalamocortical dysconnectivity is associated with baseline prodromal symptom severity. DESIGN, SETTING, AND PARTICIPANTS: In this multicenter, 2-year follow-up, case-control study, we examined 397 participants aged 12-35 years of age (243 individuals at clinical high risk of psychosis, of whom 21 converted to full-blown illness, and 154 healthy controls). The baseline scan dates were January 15, 2010, to April 30, 2012. MAIN OUTCOMES AND MEASURES: Whole-brain thalamic functional connectivity maps were generated using individuals\u27 anatomically defined thalamic seeds, measured using resting-state functional connectivity magnetic resonance imaging. RESULTS: Using baseline magnetic resonance images, we identified thalamocortical dysconnectivity in the 243 individuals at clinical high risk for psychosis, which was particularly pronounced in the 21 participants who converted to full-blown illness. The pattern involved widespread hypoconnectivity between the thalamus and prefrontal and cerebellar areas, which was more prominent in those who converted to full-blown illness (t(173) = 3.77, P \u3c .001, Hedge g = 0.88). Conversely, there was marked thalamic hyperconnectivity with sensory motor areas, again most pronounced in those who converted to full-blown illness (t(173) = 2.85, P \u3c .001, Hedge g = 0.66). Both patterns were significantly correlated with concurrent prodromal symptom severity (r = 0.27, P \u3c 3.6 x 10(-8), Spearman rho = 0.27, P \u3c 4.75 x 10(-5), 2-tailed). CONCLUSIONS AND RELEVANCE: Thalamic dysconnectivity, resembling that seen in schizophrenia, was evident in individuals at clinical high risk for psychosis and more prominently in those who later converted to psychosis. Dysconnectivity correlated with symptom severity, supporting the idea that thalamic connectivity may have prognostic implications for risk of conversion to full-blown illness